TIN SN GIT

NHM LM SNG Y6N:

PHAN TH MINH
TRNG TH TNG VI B
NGUYN TH THUN
HONG VN TR QUANG
NGUYN MINH TN
t vn

Tng huyt p c lin quan n 10% thai k

TSG/SG lun l mi quan tm hng u
TSG l nguyn nhn chnh gy nn t vong m
nh hng ln 2-8% thai k, 10% t vong m
 nh hng ca TSG cho thai ph
v thai nhi
Thai ph Thai nhi
Rau bong non IUGR
CIVD Thiu i
Suy thn cp Sinh non
Suy gan Thai suy
Xut huyt gan Cc sang chn thn kinh
Xut huyt no Bi no
Ph phi Bnh tim mch
X va ng mch Cc bnh l c ngun gc bo thai
t qu T vong
Bnh l vng mc
Cc bnh l tim mch
T vong
 nh ngha

L bnh l do thai nghn hoc nh hng ca mt thai nghn

rt gn gy nn vi s xut hin cao huyt p vi protein niu,
c hoc khng km km theo ph.
 Phn loi tng huyt p thai k

Tng huyt p mn tnh Tng huyt p thai k

20 tun

Tin sn git Tng huyt p

Protein niu
+ co git Tn thng cc c quan
= Sn git
T bo ni m:
EDRF (Endothelium-
derived relaxing
factor - yu t dn
mch
PGI2 (Prostacyclin):
kch hot qu trnh
gin mch , ngn
cn qu trnh hot
ha v kch hot
tiu cu.

Gim EDRF lm tng tc dng ca cc cht co mch nh

endothelin.
Gim Prostacyclin dn ti s xm nhp lan trn t l nui t bo n
mng rng ca nhau thai khng y .
Hu qu l khng c xm ln nguyn bo nui + co tht mch
=> truyn mu vo bnh rau t hn.
 Nhau thai thiu oxy s gii phng ra cc yu t khc
nhau.
Ph hy lp o gia, m c, lp n hi
Lm protein d dng thot ra khi lng mch.
Xut hin protein trong nc tiu
Ph
Cc triu chng ton thn khc: au u, co git,
ri lon th gic, chm pht trin thai nhi.
 I Triu chng

1. Cao huyt p: l triu chng c bn chn on xc nh

TSG. Cao huyt p c xc nh khi tui thai t 20 tun tr ln
vi cc gi tr sau:
Huyt p ti a 140mmHg hoc
Huyt p ti thiu 90mmHg.
Nhng trng hp c HAT > 30mmHg hoc HATT >
15mmHg so vi tr s huyt p c bn khi cha c thai cn
c quan tm c bit, v c th xut hin tin sn git sn
git.
Lu : Phi o HA 2 ln cch nhau 4 gi, sau khi ngh.
 I. Triu chng (tt)

2. Ph: ph ton thn, khng gim khi ngh ngi. Ph trng,

mm, n lm. Tng cn nhanh, qu 0,5kg/tun. L triu
chng khng c hiu, v ph c th xy ra trong bnh l v
tim, thn, ph do chn p, dn tnh mch, thiu dinh
dng
3. Protein niu: dng tnh khi lng protein ln hn
0,3g/L/24 gi hoc trn 0,5g/L/ mu nc tiu ngu nhin
Mc protein niu trong 24 gi: Vt 0,1 g/L
+ 0,3 g/L
++ 1,0 g/L
+++ 3 g/L
 II. Chn on tin sn git

Da vo ba triu chnh l cao huyt p, ph v protein niu.

1. Tin sn git
Tin sn git s pht trin ca tng huyt p km protein niu
c th ph sau 20 tui thai. Tnh trng ny c th xy ra sm
hn vi s hin din ca bnh l nguyn bo nui (thai trng)
Cc tiu ch chn on tin sn git l:
Huyt p: HA tm thu 140 mmHg, HA tm trng 90
mmHg xy ra sau 20 tun tui thai trn sn ph trc huyt
p bnh thng.
Protein niu: 0,3g/24 gi.
Hypertension in Pregnancy ACOG 2013
 2. Tin sn git nng

Khi c t nht mt trong nhng du hiu sau:

Huyt p ti a 160 mmHg v/ hoc ti thiu 110 mmHg.
Protein niu 5g/L.(+++).
Ri lon th gic v tri gic.
au u nhng khng p ng vi cc thuc gim au thng thng.
au vng thng v hoc phn t trn ca h sn phi.
Ph phi hoc xanh tm.
Thiu niu: lng nc tiu <500mL/24 gi.
Gim tiu cu: s lng tiu cu <150.000/mm3.
Tng men gan.
Thai chm pht trin.
III. Chn on phn bit:

Cao huyt p mn tnh: tin s c cao huyt p hoc cao

huyt p xut hin trc tun th 20 ca thai k.
Cc bnh l v thn: vim thn cp, vim thn mn, vim
m b thn, hi chng thn h.
Ph do tim, ph do suy dinh dng.
 Bin chng ca tin sn git

Bin chng cho m

H TKTW: ph no, xut huyt no- mng no
Mt: ph vng mc, m mt.
Thn: suy thn cp
Gan : chy mu di bao gan, v gan
Tim, phi: suy tim cp, OAP( gp trong tin sn git nng hoc sn git)
Huyt hc: ri lon ng chy mu, gim tiu cu, ng mu ri rc trong lng mch
Tin sn git nng, sn git c th tin trin thnh hi chng HELLP
Tiu chun chn on HELLP:
Tn huyt: nc tiu chuyn t mu vng sang mu x x, pht mu ngoi bin bt
thng, Billirubin huyt thanh > 1,3mg/dl
 Bin chng ca tin sn git

Gim tiu cu: < 100.000/ mm3

T bo gan ri lon chc nng: AST > 72 UI/L, LDH> 600
UI/L
Bin chng cho thai
Thai chm pht trin trong t cung( 56%)
non (40%)
T vong chu sinh
e do tnh mng m v con
Bin chng cho con

Thai km pht trin trong t cung

non
Thai cht trong t cung
 X tr (BYT 2016)

Nguyn tc
Pht hin yu t nguy c, gii thch
Khi c triu chng d l th nh cn iu tr ti cc c s y t
chuyn khoa
i vi th nng c bin chng: nhp bnh vin v hi chn cc
chuyn khoa, iu tr ti cc phng hi sc sn khoa.
i vi sn ph khi chuyn d hoc khi c du hiu nng, bin
chng: tin lng kp thi can thip.
 X tr ban u v qun l thai nghn

Qun l thai theo k hoch c th ti cc phng khm thai khu vc

iu tr, d kin sinh trong bnh vin c chuyn khoa sn, chuyn khoa hi sc, c phng phu thut.
Vn chuyn: cp cu ban u:
+ CS cp I.
+ Kim sot cn co git: Trc khi chuyn tim bp Diazepam 10mg x 1 ng, sau tim bp chm
Magnesi sulfat 15% 4g.
+ Kim sot h hp: t canun , pO2 > 92%, ht m.
+ Kim sot huyt p: duy tr HATD < 150 mmHg, hoc gim 10-15% trong vi gi u.
+ Sn ph c triu chng chy mu, suy thai phi hi chn v phi hp chuyn khoa ngay.
X tr chuyn khoa
bo v m, c chiu c con
(1) TSG
Ngh ngi, nghing tri
+- Diazepam 5 mg
Theo di hng tun
CDTK khi thai thng
X tr:
bo v m, c chiu c con

(2) TSG nng:

Ngh ngi, an thn (ung hoc tim), XN.

Tim truyn tnh mch Magie sulfat
H huyt p (+-) bng hydralazine, nitroglycerin,
nicardipin loi truyn tnh mch duy tr.
Khi n nh nn ly thai ra ngay.
Liu cc thuc TSG nng
Phc BV T D
 Nguy c sn git, ph phi cp c th
xy ra:

Theo di tng trng: bt rt, lo u

Du hiu thn kinh: nhc u, chng mt
Kh th, ho khan
Huyt p tng cao
Mch nhanh > 100l/ph, th nhanh>20l/ph
Phn x gn xng rt nhy
Theo di khi dng thuc chng co
git, h p( MgSO4, nicardipin)
 Ng c MgSO4

PXGX : m tnh
Nhp th: < 14 ln/ pht
Nc tiu: < 30ml/ gi
Ion Mg : 10mg/dl
x tr
1. Thng kh h tr
2. Thuc i khng: calcium gluconate, tim tnh mch 10%
10ml
-> 4 iu kin
 Theo di thai ph thc hin ng ch
iu tr

Ung thuc: Khng nn i li, sau dng thuc h p, an thn

n ung: ch n t mui, (khng qu 3g/ ngy), nhiu m (tht, c,
trng...)
Ngh ngi: nm phng yn tnh, trnh cng thng, lo u
Hng dn thai ph pht hin cc du hiu tr nng
+ Nhc u, hoa mt, tai
+ au vng thng v.
+ Du xut huyt di da
Bo ngay cho nhn vin y t
 vui ^^

1. Tin sn git thng xy ra sau tun l th

my ca thai k?
A. 10
B. 15
C.20
D. 25
 vui ^^

2. Khi iu tr Magesium sulfate cn phng s

ng c bng cch theo di 3 yu t quan trng
no?
 vui

Cch dng MgSO4 liu tn cng?

 vui

Cch dng MgSO4 liu duy tr?

 vui

4 iu kin cn m bo trong khi dng MgSO4?

 vui

Nng MgSO4 bt u gy ng c?
 vui

X tr bnh nhn ng c MgSO4?